Chronic limb ischaemia Flashcards
What is chronic limb ischaemia?
The gradual loss of blood supply to the lower limbs
What are the non-modifiable risk factors of chronic limb ischaemia?
- advanced age
- male gender
- personal history of ischaemic heart disease
- family history of ischaemic heart disease
What are the modifiable risk factors of chronic limb ischaemia?
- hypertension
- diabetes mellitus
- smoking
- hypercholesterolaemia
- obesity
- poor diet
What are the main presenting features of chronic limbischaemia?
- cramping pain (claudication) in calf, thigh or buttock after walking for a given distance, which settles on resting
- ulceration
- gangrene foot pain at rest
How is the pain described in someomne with chronic limb ischaemia?
- cramping pain (claudication) in calf, thigh or buttock after walking for a given distance, which settles on resting
What are the possible signs of chronic limb ischaemia?
- absent pulses
- poor capillary refills
- pale skin
- hair loss
- punched out ulcers
- Buerger’s angle
What is Buerger’s angle?
Angle that affected leg goes pale when raised off couch (<20%)
What classification is used to assess ischaemia?
Fontaine classification
What is teh fontaine classification?
- ⇒ asymptomatic
- ⇒ intermittent claudication
- ⇒ ischaemic resting leg pain
- ⇒ limb necrosis / ulceration / gangrene (critical ischaemia)
What is the function of ankle-brachial pressure index?
It is used to diagnose and assess severity of peripheral vascular disease
What can be used to confirm an occlusion?
USS with colour duplex
What can be used to modify risk factors?
- stop smoking
- lose weight / exercise more
- good diabetic control
- treat hypertension and hypercholesterolaemia
- clopidogrel (unless contraindicated) to reduce cardiovascular risk
- regular attendance at the foot clinic and chiropodist appointments
